Review of practice performance from Medicare - how to get the report

Requesting a comparative billing report -- Part B providers


Comparative billing report (CBR) information is available to providers by request. The purpose of the CBR is to show comparative data Medicare considers when determining how a provider’s billing patterns contrast with other providers in the same specialty. A CBR may be a helpful tool when conducting self-audits or preparing for a seminar or medical society meeting.

Types of comparative billing reports

Part B Provider-Specific

This type of CBR, best suited for individual physicians and non-physician practitioners, contains comparative information for all procedure codes billed. It is also available to specialties such as independent diagnostic testing facilities or clinical laboratories; however, due to the various types of services offered, the results will not be an “apples-to-apples” comparison. This type of CBR does not have value for physician groups.

Since Medicare bases a CBR on dates of service and not processed dates, Medicare must allow two to three months to permit claims to be finalized before a report can be generated. For example, January data is not available until April or May.

Evaluation and Management Distribution -- Provider-Specific

This type of CBR compares an evaluation and management (E/M) code family (example: CPT codes 99211-99215) to the provider’s peer group (specialty) within Florida and the nation. The report is a bar graph distribution and depicts a provider’s percentage of allowed services per procedure code as compared to Florida and the nation. This CBR is useful to identify potential variances in coding within a code family.

Medicare updates the reports two times per year for the following dates of service:

• January through June

• July through December

Since Medicare bases a CBR on dates of service and not processed dates, Medicare must allow three to four months to permit claims to be finalized before a report can be generated. For example, the January through June timeframe is not available until September or October.

Evaluation and Management Distribution -- Service-Specific

This CBR compares Florida’s utilization of E/M codes to the nation by specialty. This report is useful for medical society meetings to show variance within a code family between Florida’s provider specialties and the nation.

The CMS Data Center updates the national data two times per year for the following dates of service:

• January through June

• July through December

Medicare must allow three to four months before a report can be generated. For example, the January through June timeframe is not available until September or October.

How to request a comparative billing report

To request a CBR, providers must follow these steps:

• A provider must request a CBR on office or corporate letterhead and the provider/officer signature must be affixed. A request from a corporate entity must be submitted by a corporate officer, or in the case of a hospital, the hospital administrator. If the requesting provider wants the information sent to another party, it must be noted in the letter.

• The request must include the following information: the type of CBR(s) desired, the individual provider number(s), and the dates of service preferred. Please beware that a CBR cannot be produced using the group Medicare number.

• The mailing address must be stated clearly and legibly in the letter, since these reports will only be sent via the U.S. mail and not electronically.

• The request must be faxed to Statistical and Medical Data Analysis at 904-361-0543 or mailed to:

First Coast Service Options
Statistical and Medical Data Analysis
P.O. Box 44288
Jacksonville, FL 32231-4288

There is no fee for providing these reports.

Once Medicare receives a CBR request, the report and a CBR explanation document will be mailed to the requesting provider (or authorized party) within 10 business days.